Health care reform may be defeated this year in part because so many Americans believe the government canâ€™t do anything right and fear that a doctor will come to resemble an I.R.S. agent with a scalpel. Yet the part of Americaâ€™s health care system that consumers like best is the government-run part.

Fifty-six to 60 percent of people in government-run Medicare rate it a 9 or 10 on a 10-point scale. In contrast, only 40 percent of those enrolled in private insurance rank their plans that high.

Indeed, but that misses the point. Medicare is running in the red. Like Social Security, it is unsustainable without massive cash infusions from taxpayers.

Which taxpayers? Not we Baby Boomers — we’ll be retired. It will be our kids and our kids’ kids.

So, yes, Medicare patients are happy. Insurance companies cannot run deficits and remain in business, so they must mind costs, and that means saying “no” to people who don’t want to hear it. Which includes all of us.

Obama’s team estimates that Medicare suffers from 30% waste and fraud. No business would tolerate that.

Atul Gawande wrote about two adjacent Texas counties with identical demographics. One county has twice the medical costs and Medicare didn’t seem to know a thing about it.